Catastrophic Care: Why Everything We Think We Know about Health Care Is Wrong (Vintage) Paperback – 15 Nov. 2013

people need to know about this book and the absolute monstrosity that is the pharmaceutical industry. Natural, organic, food and food products and exercise or so important people wake up!!!

This book should be required reading for anyone who's ever wondered, "well, what exactly is so bad about our healthcare system?" In this fascinating read, David Goldhill approaches the matter of care from the lens of a business person, which I can wholly appreciate. The problems we face in healthcare today, he contends, are primarily a result of a broken marketplace for healthcare. We are not consumers in this system, we are pawns for powerful surrogates to extract profit from.Goldhill takes us on a whirlwind tour of almost literally every facet of care I've never even thought about, from Medicare and Medicaid to the broken rewards systems that are powering the next generation of physicians. Overall, I felt the analysis was incredibly well done and well researched, little was left to the imagination as to why and where our system has failed us, and even though the book itself seems to have come out before the ACA was enacted, it seems mildly prophetic in a lot of ways in showing how a continuation of a broken system can only continue to be broken.I think my favorite part of the book is that it doesn't heavily lean into the idea that America should be like Norway or Finland. It surprised me to learn those systems are also heavily problematic in terms of controlling cost. Rather, a more interesting example forward for America is Singapore, of all places.By the end of the book, we're treated to a comprehensive assessment of how to fix a system that waylays itself with profligate actors that have no incentive to change. In the next 5 years, we're likely to see a collapse in Medicare expenditures in a similar fashion to what happened with the housing industry. Goldhill's solution is elegant and pragmatic, in my opinion. He prescribes a three-pronged system that simultaneously moves incentives for insurers to only truly insure against catastrophic events, for marketplace consumers to save their own money and demand cost-effective care at a basic level and to do all this while managing to either spend the same amount of money we're currently pouring into a broken system or to even save money while doing it.

If you start your career at age 22 in a $35K job, work until age 65 with a 4% bump each year, you will have earned about $3.85 million over those years.Guess how much of that you will have paid into the healthcare system -- through Medicare and Medicaid taxes, through your share of premiums, out-of-pocket, co-pays, and the portion of your compensation that your employer pays in health insurance premiums.$1.9 million -- assuming that, miraculously, the costs of healthcare and health insurance suddenly stabilized to keep pace with the CPI instead of beating by 150 to 200 percent a year as it does now.David Goldhill takes a deep, deep dive into the way our healthcare system works. Or doesn't, as a nation with the best medical technology and (arguably) the most talented medical personnel has outcomes that are middling at best.He explains why our current financial model for healthcare is unsustainable (obviously, since it eats half our incomes). But he also explains why "Medicare for all" or any third-party pay system will never control costs.This book is a must-read for anyone involved in making healthcare policy. And for anyone who'd like to find a way to not pay half his or her income for healthcare insurance and services. And, yes, it offers a realistic, tested and proven solution -- an example in which superior outcomes are provided at significantly lower cost in a nation whose demographics closely reflect our own.

By profession, I think and talk about health care quite a bit. Sure, it's insanely expensive; sure, it's dangerous; sure, it's appallingly inaccessible, even to people with money and time to spend trying to figure out out. But until I read this book, it didn't occur to me to question the underlying principle of our health system--namely, that insurers of various kinds (private companies, government agencies) are naturally and necessarily interposed between human beings and medical care. This book exposed that principle as a historical accident -- and the health system it sustains as a perfect machine for producing human misery and economic devastation. In making that argument, this book changed my mind about single-payer health insurance (I no longer think it'll help), about the utility of market forces (I now think they matter), and even housing policy (!). This book should be required reading for anyone in healthcare or health policy, and it would help anyone with a human body who anticipates needing medical attention at some point. Brilliant.

I’ve worked in healthcare administration for the past 5 years, during which I’ve read many takes on the issues plaguing our health system. As someone who came into healthcare from outside industries, I love my work but have often been stunned by levels of inefficiency and dysfunction that would never be tolerated in any other sector. I’ve never read anything, however, that makes full sense of what I’ve experienced....until now, that is. Goldhill breaks down the root cases of our system’s problems in a way that almost anyone can understand. And his solutions? Jarringly simple, yet logically sound. Brilliant stuff.

Catastrophic Care - How American Health Care Killed MY Father - And How we can Fix ItByDavid GoldhillInfections from a hospital stay killed David Goldhill's father in 2007, one of more than 200,000 deaths annually caused by medical error. The medical bill was huge and fully paid by Medicare. David wanted to know why it happened and why a business was paid after such a colossal error. This would not happen in a market driven business. This book is the result of Mr. Goldhill's quest for answers.The major premise of Mr. Goldhill's book is that the patient is not the customer. The actual customers are what he calls "surrogates" and these are private insurers, Medicare and Medicaid. All of these are institutions begun with the best of intentions that have grown into unwieldy, inefficient behemoths over the last 45 years and have established a culture in our Health Care arena that is going to be difficult to change.Originally, health insurance was in place to take care of "catastrophes" and not the common cold or the equivalent. We have turned an insurance into a "payment mechanism" over the years.The "surrogates" have become the consumers and are driving the market. They are profit driven, not market driven and have created a 3rd party administration that continues to drive up the price of health care and not, necessarily the efficiencies. The "Surrogates" along with the pharmaceuticals operate with a unique set of rules and, ironically, the higher premiums are, the higher the profits.In a true market scenario, prices drop and things become better and/or more efficient. The most obvious analogy is computers. The first laptops were thousands of dollars; you can now buy a better one for about $350.00. Lasik surgery and most cosmetic surgeries prices drop because of competition. Why? They are not covered by insurance, thus no surrogates.We, as the patients, have come to accept the status quo. We go crazy when a gallon of gas rises by 10 cents, however, just accept the fact that medical procedures continue to escalate because the surrogates are in control and we are just paying the deductibles. The surrogates benefit from rising prices.So, what about the Affordable Care Act [Obamacare or ACA]? More of the same. We need to create a new system that is not procedure driven, is a true marketplace and is driven by the true customer, the patient. This will take a minimum of a generation; however, it can be done.Mr. Goldhill presents a possible scenario that places the patient in control and promotes transparency in costs in the medical field. His suggestion is a combination of a very high deductible in true catastrophic insurance, health accounts and health loans. I am not sure if that is the answer, but he presents a convincing argument and makes it very clear that the present situation in health care is unsustainable.My suggestion is that you read this well-written and well researched book and get your legislators to do the same. Thanks to Mr. Goldhill for presenting such a well articulated case in a tremendously complex situation.

Written for a general (but thinking) audience, this book could really turn around all public discourse on health care and become a seminal work on the subject.The divisive health care debate of recent years is centered over WHO should shoulder astronomic medical costs. The issue of taming the exorbitant prices and costs is relegated to the side issue of waste and abuse. David Goldhill takes a new and different approach. He puts aside the standard assumption that health care is somehow exempt from the normal rules of economic activity. He focuses on WHY the costs became so exorbitant in the first place. Goldhill shows persuasively that the costs are the result of the very design of our current medical system, and the only way to bring the costs down to earth is to REPLACE entirely the current economic arrangements of our medicine - both the private insurance system and Medicare/Medicaid.That's a book of new ideas. These ideas are breakthrough innovative, brilliant, deeply thought through; analysis superb. As with all things new and complex, it requires an effort to understand. If you have any background or interest in economics, even the economics of everyday life, give it more consideration.

Reading this very entertaining book will leave you smarter than almost every health care reporter who claims to know what they're talking about. It may be the most important public policy book written in the last 30 years.If anyone in public life - journalist or politician - claims to understand American health care policy and yet cannot explain why the word "Singapore" and/or the name "David Goldhill" is relevant, then they are likely perpetuating the problem rather than understanding solutions.

Highly recommended. The author makes a clear and compelling argument that basic economic forces should have the primary role in allocating scare healthcare dollars. Without standard market incentives and the interplay between buyers and sellers - like we see in the normal world for housing, food and other essential goods and services - the US will never be able to control the runaway costs of healthcare. The growth of Big Healthcare is staggering, and scary.

Goldhill speaks from his heart, and takes off the gloves in this honest and painful examination of America's healthcare system. He does not waste time comparing US to UK or any other country as that process is as useless as comparing apples and oranges. What matters most is how America has failed at being as good as American medicine could be if the corruption and waste and incompetence were removed from the equation. He does not sugar coat the reality. The US system is headed for a crash, and Obama Care is going to make it worse, not better. Everyone should read this. If Ameirca's leaders read it there is hope that common sense will someday prevail to save the system from utter collapse.

Wow, what a striking read. I’ve given this to a few friends who are proponents of socialized medicine and it’s safe to say this has given them a reason to stop and ponder. It doesn’t get more straight forward than this in the healthcare industry. “Having insurance is not the same as having healthcare.” Must read especially in today’s political climate.

An extremely well written health policy book for the common man, "Catastrophic Care" offers a detailed, thoughtful assessment of what ails our current healthcare system. While " The Innovator's Prescription: A Disruptive Solution for Health Care " was also a superb analysis of health care as a business, "Catastrophic Care" is far more reaching, and absolutely better researched with a plethora of devastating facts and statistics, updated to include discussion of the Affordable Care act.As a physician, I can attest to Mr. Goldhill's many examples of skewed incentives leading to sloppy care as the rule, rather than the exception. The book asserts that for care to become TRULY patient-centered, the patient must become the customer and stop relying on surrogate (insurance or government) reimbursement methods. Only when we demand control over how our healthcare dollars are spent can we hope to achieve the safe, high-quality, service oriented care that we deserve. The Innovator's Prescription: A Disruptive Solution for Health Care

Mr. Goodwill diagnosis of what is wrong with American healthcare today is spot on! While, his cure moves us in the right direction, too much of it involves government forcing consumers to behave a certain way. This will distort the market reforms that he advocates for as the primary solution to drive down the real costs of healthcare.Regardless, this book is a must read for everyone.

A thorough and well researched overview of our current US health care industry with a focus on uncovering the root causes of rising prices and many other problems. An easy read designed for a general audience. Excellent footnotes. Interesting principles and ideas for transforming the system in a radical but realistic way over a politically acceptable time period.

I loved Mr. Goldhill's article in the Atlantic about the same topic. Here, he expands on his analysis of the misplaced incentives in the healthcare system and provides a very interesting potential solution. I have purchased this book for several friends who are interested in health care policy.